Association between Co-Morbidities and the Prevalence of Excessive Daytime Sleepiness over a Four-Year Period

Excessive daytime sleepiness (EDS) is a common problem in general the Canadian population. It can effect day-to-day activities and is also associated with several health issues. This study aimed to investigate the association between co-morbidities and the prevalence of EDS over a four-year period in adults living in two First Nation communities. Data collected during the First Nations Lung Health Project (FNLHP) conducted in two Cree First Nation communities in Saskatchewan in 2012–2013 (Cycle 1) and 2016 (Cycle 2) were used for this analysis. There were 859 participants aged 18 years and older at baseline (Cycle 1) and 821 participants aged 18 years and older at follow-up (Cycle 2) who completed the interviewer-administered questionnaire. An Epworth Sleepiness Scale (ESS) score > 10 was considered to be abnormal and identified as a case of EDS at both time points. A multilevel logistic regression model using a generalized estimating equations approach was used to analyze the data. The prevalence of EDS at baseline (Cycle 1) was 11.2% (91/815) and 10.0% (80/803) at follow-up (Cycle 2). Based on the predicted model, longitudinal change in the prevalence of EDS was −0.11% for 358 individuals who participated in both cycles. There were 49% males at baseline and 48% males at follow-up. Multivariate regression model results revealed that crowding, shortness of breath, loud snoring, chronic lung disease, depression and gastric reflux were the main significant predictors of EDS. In addition, the interaction between sex and age was significant. Some of the co-morbid conditions were associated with EDS. Therefore, managing such conditions requires considerations in strategies to decrease the prevalence of daytime sleepiness.

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Incidence of Daytime Sleepiness and Associated Factors in Two First Nations Communities in Saskatchewan, Canada

Clocks & Sleep ◽

10.3390/clockssleep1010003 ◽

2018 ◽

Vol 1 (1) ◽

pp. 13-25 ◽

Cited By ~ 1

Author(s):

Chandima Karunanayake ◽

James Dosman ◽

Donna Rennie ◽

Joshua Lawson ◽

Shelley Kirychuk ◽

...

Keyword(s):

First Nations ◽

Daytime Sleepiness ◽

Housing Conditions ◽

Health Issues ◽

Logistic Regression Models ◽

The Past ◽

Health Project ◽

The Mean ◽

Lung Health

Excessive daytime sleepiness (EDS) is the tendency to sleep at inappropriate times during the day. It can interfere with day-to-day activities and lead to several health issues. The objective of this study was to investigate the association between income, housing conditions, and incidence of EDS in adults living in two Cree First Nations communities. The data for this study involved 317 individuals aged 18 years and older who participated in baseline and follow-up evaluations (after four years) of the First Nations Lung Health Project, which was conducted in Saskatchewan in 2012–2013 and 2016. Both at baseline and follow-up survey after four years, an Epworth Sleepiness Scale (ESS) score >10 was considered to be abnormal. Logistic regression models were used to assess relationships between abnormal ESS and covariates at baseline. In 2016, 7.6% (24/317) of the participants reported an ESS >10 with the mean being 12.8 ± 2.0. For the same group, the mean ESS at baseline was 6.9 ± 2.2. The incidence of subjective EDS based on the ESS >10 was estimated at 7.6% over four years. This study showed an association between incidence of subjective EDS and less money left over at end of the month, having a house in need of repairs, having water or dampness in the past 12 months, and damage caused by dampness.

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Improved follow-up by peripheral arterial tonometry in CPAP-treated patients with obstructive sleep apnea and persistent excessive daytime sleepiness

Sleep And Breathing ◽

10.1007/s11325-018-1668-9 ◽

2018 ◽

Vol 22 (4) ◽

pp. 1153-1160 ◽

Cited By ~ 2

Author(s):

C. Schöbel ◽

S. Knorre ◽

M. Glos ◽

C. Garcia ◽

I. Fietze ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Peripheral Arterial Tonometry ◽

Arterial Tonometry ◽

Obstructive Sleep ◽

Peripheral Arterial

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Excessive Daytime Sleepiness and Cardiovascular Mortality in US Adults: A NHANES 2005–2008 Follow-Up Study

Nature and Science of Sleep ◽

10.2147/nss.s319675 ◽

2021 ◽

Vol Volume 13 ◽

pp. 1049-1059

Author(s):

Jingen Li ◽

Naima Covassin ◽

Joshua M Bock ◽

Essa A Mohamed ◽

Lakshmi P Pappoppula ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Follow Up Study

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Cerebrospinal fluid orexin-A levels in systemic lupus erythematosus patients presenting with excessive daytime sleepiness

Lupus ◽

10.1177/0961203318778767 ◽

2018 ◽

Vol 27 (11) ◽

pp. 1847-1853 ◽

Cited By ~ 2

Author(s):

K Suzuki ◽

M Miyamoto ◽

T Miyamoto ◽

T Matsubara ◽

Y Inoue ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cerebrospinal Fluid ◽

Lupus Erythematosus ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Acute Stage ◽

Systemic Lupus ◽

Orexin A ◽

Hypothalamic Lesions

Objective Involvement of the hypothalamus is rare in patients with systemic lupus erythematosus (SLE). In this study, we measured cerebrospinal fluid (CSF) orexin-A levels in SLE patients with hypothalamic lesions to investigate whether the orexin system plays a role in SLE patients with hypothalamic lesions who present with excessive daytime sleepiness (EDS). Methods Orexin-A levels were measured in CSF from four patients with SLE who presented with hypothalamic lesions detected by MRI. Three patients underwent repeated CSF testing. All patients met the updated American College of Rheumatology revised criteria for SLE. Results Tests for serum anti-aquaporin-4 antibodies, CSF myelin basic protein and CSF oligoclonal bands were negative in all patients. All patients presented with EDS. Low to intermediate CSF orexin-A levels (92–180 pg/ml) were observed in three patients in the acute stage, two of whom (patients 1 and 2) underwent repeated testing and showed increased CSF orexin-A levels, reduced abnormal hypothalamic lesion intensities detected by MRI and EDS dissipation at follow-up. In contrast, CSF orexin-A levels were normal in one patient (patient 4) while in the acute stage and at follow-up, despite improvements in EDS and MRI findings. Patient 4 showed markedly increased CSF interleukin-6 levels (1130 pg/ml) and a slightly involved hypothalamus than the other patients. Conclusions Our findings suggest that the orexinergic system has a role in EDS in SLE patients with hypothalamic lesions. Furthermore, cytokine-mediated tissue damage might cause EDS without orexinergic involvement.

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Natural history of excessive daytime sleepiness: a population-based 5-year longitudinal study

SLEEP ◽

10.1093/sleep/zsz249 ◽

2019 ◽

Vol 43 (3) ◽

Cited By ~ 1

Author(s):

I Jaussent ◽

C M Morin ◽

H Ivers ◽

Y Dauvilliers

Keyword(s):

Sleep Duration ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Adult Population ◽

Population Based ◽

Normal Weight ◽

Point Reduction ◽

Nighttime Sleep ◽

Over Time

Abstract Study Objectives To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS). Methods Participants were recruited in 2007–2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score >10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years. Results Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms. Conclusions EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population.

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Determinants of excessive daytime sleepiness in two First Nation communities

BMC Pulmonary Medicine ◽

10.1186/s12890-017-0536-x ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 4

Author(s):

Ina van der Spuy ◽

Chandima P. Karunanayake ◽

James A. Dosman ◽

Kathleen McMullin ◽

Gaungming Zhao ◽

...

Keyword(s):

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

First Nation

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P080 An embedded pathway to mandibular advancement splint (MAS) construction in a tertiary hospital reduces barriers to care for low-income individuals

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.124 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A47-A47

Author(s):

B Lim ◽

T Yap ◽

M Lim ◽

A Gikas

Keyword(s):

Low Income ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Dental Treatment ◽

Treatment Compliance ◽

Tertiary Hospital ◽

Mandibular Advancement ◽

Mandibular Advancement Splint ◽

Tertiary Hospitals

Abstract Introduction The aim of this study was to report the outcomes of patients referred within and to a tertiary hospital dental unit for subsidised construction of a MAS over a 5-year period. Methods Medical records of patients referred from 2015–2020 were examined for reason for referral, details of diagnosis, pathway to diagnosis, treatment, compliance, clinician-reported and lab-based outcomes and follow-up reviews. Results One hundred patients referred from: The Hospital Sleep Unit 40, other Tertiary Hospitals 27, Private Sleep Clinics 13, Medical GPs 10. 76 patients were confirmed health care card holders. 30 patients did not proceed for reasons of cost or poor oral health. 59 patients were newly fitted with a MAS (27F,32M), 17 severe, 21 moderate, 17 mild OSA, mean age 52.9(+13.9) years, BMI 30.2(+6.3) kg/m2, ESS 11.4(+5.3). 22 of 36 patients with serial ESS scores had excessive daytime sleepiness upon initial presentation. 15/22(68%)(p<0.005) of patients had resolution of their excessive daytime sleepiness following MAS wear. 8/15(53%) of patients had a subsequent AHI <50%. 33 patients (56%) continued MAS wear, mean follow-up time 13.8(±14.6) months with an average of 5.8(+3.0) visits. 6 were lost to follow up, 20 patients (33%) ceased MAS wear with 10(50%) of these stopping because routine dental treatment affected the device fit or discomfort later developed. Conclusion Subsidised expert construction of MAS embedded in a tertiary hospital is a well-utilised and effective service which reduces barriers for patients. The referrals to this service appear to be appropriate, with most patients proceeding to MAS construction.

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A 10-Year Follow-Up of Excessive Daytime Sleepiness in Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2019/5708515 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Arja Höglund ◽

Peter Hagell ◽

Jan-Erik Broman ◽

Sven Pålhagen ◽

Kimmo Sorjonen ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Motor Symptoms ◽

Sleep Habits ◽

Standardized Interview ◽

Nonmotor Symptom ◽

Anxiety Depression

Introduction. The aim of this prospective study was to investigate excessive daytime sleepiness (EDS) over time and in relation to other PD symptoms among people with Parkinson’s disease (PD). Methods. Thirty participants younger than 65 years with PD were randomly selected. At inclusion, mean (SD) disease duration was 6.2 (4.8) years and median (min-max) severity of PD was classified as stage II (stages I–III) according to Hoehn and Yahr. Participants were followed annually for 10 years with clinical assessments of their PD status, medications, comorbidities, and a standardized interview about their sleep habits and occurrence of daytime sleepiness. EDS was assessed by the self-reported Epworth Sleepiness Scale (ESS). Seventeen participants completed the 10-year longitudinal follow-up. Results. Fifteen of 30 persons were classified to suffer from EDS (ESS > 10) at baseline. At the group level, EDS remained stable over 10 years and did not deteriorate in parallel with worsening of motor symptoms. Furthermore, EDS was associated with sleep quality, fatigue, anxiety, depression, and axial/postural/gait impairments. Conclusions. EDS did not worsen over 10 years, although other PD aspects did. EDS in PD seems to be a complex nonmotor symptom that is unrelated to deterioration of motor symptoms in PD.

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Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database

Frontiers in Neurology ◽

10.3389/fneur.2021.690008 ◽

2021 ◽

Vol 12 ◽

Author(s):

Maria R. Bonsignore ◽

Jean L. Pepin ◽

Fabio Cibella ◽

Calogero D. Barbera ◽

Oreste Marrone ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Excessive Daytime Sleepiness ◽

Daytime Sleepiness ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Interquartile Range ◽

Obstructive Sleep

Excessive daytime sleepiness (EDS) is a symptom of obstructive sleep apnea (OSA) that resolves under treatment with continuous positive airway pressure (CPAP). In some patients, sleepiness persists despite CPAP treatment. We retrospectively analyzed data on subjective residual EDS, assessed as an Epworth Sleepiness Scale score (ESS) >10, in patients from the European Sleep Apnea Database (n = 4,853, mean age ± SD 54.8 ± 11.8 years, 26.1% females), at baseline and at the first visit (median follow-up: 5 months, interquartile range 3–13). An ESS > 10 occurred in 56% of patients at baseline and in 28.2% of patients at follow-up. Residual EDS was analyzed in 2,190 patients (age: 55.1 ± 12.0 years, 26.1% females) with sleep monitoring data (median follow-up: 3 months, interquartile range 1–15). Sleep studies during CPAP use were obtained in 58% of these patients; EDS was reported by 47.2% of patients at baseline and by 30.3% at follow-up. Residual OSA, defined as an apnea–hypopnea index >10/h, and insufficient CPAP adherence, defined as nightly use <4 h, occurred with similar frequency in patients with and without EDS at follow-up. Prevalence of residual EDS was highest (40%) in patients with a first follow-up visit at 0–3 months, then it was 13–19% in patients with a first follow-up visit after 4 months to 2 years. The change in ESS (n = 2,190) was weakly correlated with CPAP use (R2 = 0.023, p < 0.0001). Logistic regression showed that an ESS score >10 at the first follow-up visit was associated directly with ESS at baseline and inversely with duration of follow-up, and CPAP use (R2 of the model: 0.417). EDS showed heterogeneity in different European countries both at baseline and at the first follow-up visit, suggesting modulation by cultural and lifestyle factors. In conclusion, residual EDS in CPAP-treated OSA occurred in approximately one in four patients at follow-up; its prevalence was highest (40%) in the first 3 months of treatment and subsequently decreased. The finding of residual EDS in a significant percentage of optimally treated OSA patients suggests that wake-promoting agents may be useful, but their indication should be evaluated after at least 3 months of treatment.

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